Systems Configuration Analyst, Pricing
Requisition #: 188799
Location: Johns Hopkins Health Care,
Category: Non-Clinical Professional
Work Shift: Day Shift
Work Week: Full Time (40 hours)
Weekend Work Required: No
Date Posted: July 19, 2019
Johns Hopkins Health System employs more than 20,000 people annually. Upon joining Johns Hopkins Health System, you become part of a diverse organization dedicated to its patients, their families, and the community we serve, as well as to our employees. Career opportunities are available in academic and community hospital settings, home care services, physician practices, international affiliate locations and in the health insurance industry. If you share in our vision, mission and values and also have exceptional customer service and technical skills, we invite you to join those who are leaders and innovators in the healthcare field.
The Systems Configuration Analyst, Pricing will facilitate the “loading of fee schedules” versus benefit categories. In addition, the incumbent will identify and troubleshoot issues associated with Provider Contract and fee schedule discrepancies as well as systems adjudication logic within the provider pricing structure and recommend changes to ensure claims are paid in accordance with the provider agreement. The Systems Configuration Analyst II, Pricing, will assist the Coding Compliance Specialist and the Manager, Business Support with the development and implementation of processes that improve current business flow and create efficiencies within the end product delivery. The Systems Configuration Analyst II, Pricing, will also interface with the Systems Configuration Analyst II, Benefits, and Benefit Plan Analysts to perform required testing of benefit adjudication rules and ad-hoc changes to benefit setups in MC400.
Requires an Associate’s Degree with 3 years equivalent industry experience, specifically claims, provider and/or benefits. Additional related work experience may be substituted for some education.
Systems Configuration Analyst, Level II -
Requires a Bachelor’s Degree in Business, HealthCare Management or related discipline or Associates Degree with 5 years equivalent industry experience, specifically claims processing and systems.
Must be able to understand medical terminology and medical claim forms (UB04 and HCFA 1500). Knowledge of claims processing and adjustments is strongly preferred. Knowledge of claims systems is preferred.
Systems Configuration Analyst, Pricing -
Requires thorough knowledge and understanding of ICD-9, CPT, HCPCS and Revenue codes. Must be able to understand medical claim forms (UB92 and HCFA 1500) as well as modifiers and the RBRVS payment methodology. Requires familiarity of institutional and professional provider contracts, fee schedules and reimbursement methodologies. Knowledge of claims processing and adjustments is strongly preferred. Knowledge of MC400 system is preferred.
Must demonstrate ability to resolve issues quickly, make decisions and institute change when appropriate. Must possess the ability to draw accurate and timely conclusions and be able to communicate them effectively to management, other staff members and external clients while being sensitive to the contractual and client relationships at stake. Must demonstrate the ability to be self-motivated, have excellent organizational, oral and written communication skills. Requires strong analytical ability to bring together and solve complex problems that involve the member’s benefit plan and the provider pricing setup to properly adjudicate the claim. Must be very detailed oriented and be able to maintain focus while working with large sets of data and claims information. Must demonstrate (at a minimum) intermediate skill level with Microsoft office packages, specifically Excel and Word with the ability to create and manipulate program worksheets. Knowledge and experience with Microsoft Access is preferred.
D. Required Licensure, Certification, Etc.:
E. Work Experience:
Requires a minimum of 3 years’ experience in the healthcare industry including 2 years in an on-line adjudication claims system within a managed care environment. Included in the 3 years, a minimum of 1 year experience in system updating and testing. Test and Production environment system experience is strongly preferred.
Systems Configuration Analyst, Level II -
Requires a minimum of 5 years’ experience in the healthcare industry including 3 years in an on-line adjudication claims system within a managed care environment. Included in the 5 years, a minimum of 2 years’ experience in system updating and testing with CPT/HCPSC/ICD9 coding, fee schedules and benefits plans is preferred. MC400 TEST and Production environment system experience is strongly preferred.
F. Machines, Tools, Equipment:
Must be able to operate a PC, PC applications, and general office and communications equipment
Pay Grade: NG/NI
Johns Hopkins Health System and its affiliates are Equal Opportunity/Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sexual orientation, gender identity, sex, age, national origin, disability, protected veteran status, and or any other status protected by federal, state, or local law.